Choosing orthodox drugs and/or herbs.
No, I am not here to advise you not to take your Sertraline, or Fluoxetine /Prozac or Citalopram, or any other….
Why? Because I don’t know you, nor do I know why your GP may have prescribed it. I also don’t know [because I haven’t talked to you] what you feel like, nor what I would do [if anything] to replace it.
Even though recent studies by University College London suggests that ‘depression is not likely caused by a chemical imbalance, and calls into question what antidepressants do’ 1 some of my patients have found that, whatever the mechanism, they do help for a certain period of time.
Other medications than these SSRIs can be used, such as tricyclic antidepressants [TCAs] which work in a similar way but involving a wider range of receptors [not just serotonin]. TCAs such as amitriptyline are tried when first line treatments don’t work. However, they can be lethal in overdose and have more problematic side effects [dry mouth, blurred vision, cardiac arrhythmia, postural hypotension and tachycardia]2
I wouldn’t try to convince anyone to stop taking their medication because depression isn’t something to take lightly, it can be a strong enough motivator to cause end-of-life ideation, and I wouldn’t mess about with a severely depressed patient who is about to be admitted to hospital.
But I don’t think medicinal herbs should be dismissed out of hand.
I have had patients who, understandably, couldn’t wait for the couple of months for a herbal regime to take full effect, even then it can take time to match the right herb to each patient. Orthodox drugs can have a much quicker effect, if they are the right drug. You see, the ‘hit-or-miss approach’ is something that orthodox treatment has to grapple with too within the field of mental health; ‘inconsistent results are seen with the classes of drugs considered to be first line treatment.’3
Unfortunately, even if drugs are effective this effect doesn’t always last very long; Dr Chris Palmer in his book Brain Energy relates a study of 431 depressed patients on medication and found that ‘symptoms would fluctuate, sometimes going away but then coming back, even with treatment, even if they took medications every day…They either continued to have low-grade lingering symptoms or they would come in and out of bouts of major depression.’ p20.
He then goes on to explain how this reflects ‘what anyone who has worked in the mental health field for a number of years already knows to be the case. Almost two-thirds of depressed patients don’t experience remission.’
It is true that it is not just the fault of the medication, because other interventions can also experience limited success; stress management, meditation, group therapy, psychotherapy and more…
But one thing that is not usually tried is a change in diet together with medicinal herbs.
And that is why I think that anybody with a mental health disorder, or who knows somebody who struggles with one, should read Dr Chris Palmer’s book. They should read it because he addresses diet in a major way and gets extremely good results, and I have to say it comes with much more authority from him than it does from me, as he is a Harvard educated consultant psychiatrist with decades of experience in the mental health field.
And to his recommendations of dietary change, I would add this;
- Whether taking herbs or conventional drugs, we can’t expect to take a course of medicine and then be completely fine. Depression is complicated. We need to try a mix of things and be patient.
- Herbs can have gentle antidepressant actions without causing weight gain, or sedating a patient so they feel like they have no emotions left.
- Herbs deliver much more than ‘medication’, they provide extra vitamins and minerals, polyphenols and anti-inflammatories.
- Try to get out in the fresh air, even if it is not for ‘exercise’. An NHS consultant said to me once, ‘for someone in your situation [I had just been delivered of a stillborn baby boy] I would prescribe anti-depressants. But God didn’t create us to be stuck inside concrete buildings all day. Get out into the fresh air – feel the sun on your face, and the wind in your hair…’
Even though many orthodox professionals have little regard for plant medicine, some authorities have acknowledged that there are some that might be useful, ‘A number of complementary and alternative products have evidence for treating depression.’ 4 Among those mentioned are Valerian and St John’s Wort which are very commonly cited in the complementary treatment options for depression. However there are many others, and if you are interested in trying a more natural route to tackle mild to moderate depression then you can find qualified practitioners here: www.nimh.org.uk
If you are already taking conventional anti-depressants, don’t just stop taking them. If you have a major depressive episode, contact your GP or consultant.
1 https://www.ucl.ac.uk/news/2022/jul/no-evidence-depression-caused-low-serotonin-levels-finds-comprehensive-review Accessed 24/04/24
2 Farach, FJ., Pruitt, LD., Jun, JJ., Jerud, AB., Zoellner, LA., Roy-Byrne, PP. (2012) Pharmacological treatment of anxiety disorders: Current treatments and future directions.Journal of Anxiety Disorders. Volume 26, Issue 8, pp 833-843 https://www-sciencedirect-com.libezproxy.open.ac.uk/science/article/pii/S0887618512000977
3 Maron, E. and Nutt, D. (2015) ‘Biological predictors of pharmacological therapy in anxiety disorders’, Dialogues in Clinical Neuroscience, 17(3), pp. 305-317.
4 Locke, A.B., Kirst, N. and Shultz, C.G. (2015) ‘Diagnosis and management of generalized anxiety disorder and panic disorder in adults’, American Family Physician, 91(9), pp. 617-624.
